Indications/Contraindications

Indications:

Lung transplants are indicated for patients with End Stage Lung Disease for which maximal medical therapy is being ineffective or there is no proven therapy. These include but are not limited to:

  • Idiopathic Pulmonary Fibrosis (IPF)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Cystic Fibrosis
  • Idiopathic Pulmonary Arterial Hypertension
  • Sarcoidosis
  • Lymphangioleyomyomatosis (LAM)

Absolute Contraindications:

  • Malignancy within the last 2 years, except for non-melanoma skin cancers (a 5 year disease-free interval is preferred)
  • Untreatable dysfunction of another organ system (selected patients with CAD can undergo a lung transplant)
  • Active chronic hepatitis C or B with histological evidence of liver damage
  • HIV infection
  • Significant chest wall deformities
  • Documented non-adherence to medical therapy or follow up
  • Severe psychiatric illness
  • Unreliable social support system
  • Active substance addiction (tobacco, alcohol, narcotics) or within 6 months
  • Class II obesity or higher defined as a body mass index (BMI) exceeding 35 kg/m2

Relative Contraindications:

  • Age > 65 years
  • Critical or unstable clinical condition (e.g., shock, mechanical ventilation or extra-corporeal membrane oxygenation)
  • Severely limited functional status poor rehabilitation potential (6MWT distance < 600 ft.)
  • Colonization with highly resistant or highly virulent bacteria, fungi or mycobacteria
  • Class I obesity defined as a body mass index (BMI) between 30-34.9 kg/m2
  • Severe or symptomatic osteoporosis
  • Mechanical ventilation (carefully selected candidates on mechanical ventilation without other acute or chronic organ dysfunction who are able to actively participate in a meaningful rehabilitation program may be successfully transplanted)
  • Other medical conditions that have not resulted in end-stage organ damage, such as diabetes mellitus, systemic hypertension, peptic ulcer disease, or gastro esophageal reflux should be optimally treated before transplantation
  • Patients with coronary artery disease may undergo percutaneous intervention before transplantation or coronary artery bypass grafting